Improved Outcomes with Hypothermic Machine Perfusion in Donation after Circulatory Death Liver Transplantation.
Publication/Presentation Date
4-1-2026
Abstract
BACKGROUND: Donation after circulatory death (DCD) allografts were not widely used in liver transplantation (LT) due to higher rates of biliary complications and retransplantation. Although European trials have shown improvement in early allograft function and biliary complications with hypothermic-oxygenated machine perfusion (HMP-O2) compared with traditional static cold storage (SCS) on ice, no US clinical series have demonstrated a benefit.
STUDY DESIGN: All DCD LTs performed at a single center from April 6, 2015, to December 24, 2024, were evaluated. DCD-HMP-O2 transplants were performed under a clinical trial (NCT03484455 and NCT05574361). Six-month outcomes were compared between those preserved with SCS (n = 47) vs HMP-O2 (n = 62).
RESULTS: Among 109 DCD LT recipients, the median age was 61 years, 29.4% were female, with a BMI of 29.6 kg/m 2 and a Model for End-Stage Liver Disease score of 16. DCD-HMP-O2 donors were older (51 vs 37 years, p < 0.001), had longer functional warm ischemia time (23 vs 18 minutes, p < 0.001), higher UK-DCD risk scores (8 vs 3, p < 0.001), and longer preservation times (9.1 vs 4.7 hours, p < 0.001). DCD-HMP-O2 recipients had lower incidence of primary nonfunction (0.0% vs 6.4%, p = 0.04), nonanastomotic biliary strictures (1.6% vs 14.9%, p = 0.008), and ischemic cholangiopathy (1.6% vs 10.6%, p = 0.04) compared with DCD-SCS recipients. After adjustment, HMP-O2 use was associated with 97% lower odds of ischemic cholangiopathy (adjusted odds ratio 0.03, 95% CI 0.01 to 0.71, p = 0.03) compared with SCS.
CONCLUSIONS: In this first US study of HMP-O2 use in DCD LT, HMP-O2 decreased primary nonfunction and biliary complications compared with SCS, despite the use of higher risk DCD allografts. With the exponential rise in DCD use, HMP-O2 can improve clinical outcomes for these recipients.
Volume
242
Issue
4
First Page
775
Last Page
781
ISSN
1879-1190
Published In/Presented At
Haugen, C. E., Pratt, C. G., Kelty, C., Guillory, D. J., Chang, A. L., Guarrera, J. V., Shah, S. A., Gerber, D. A., & Quillin, R. C., 3rd (2026). Improved Outcomes with Hypothermic Machine Perfusion in Donation after Circulatory Death Liver Transplantation. Journal of the American College of Surgeons, 242(4), 775–781. https://doi.org/10.1097/XCS.0000000000001790
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
41562449
Department(s)
Administration and Leadership
Document Type
Article